Top-of-the-mind health care topics in states are Medicaid and implementation of the federal Affordable Care Act. Medicaid enrollment continues to grow, federal stimulus funds have disappeared, and in many states providers are pressuring for increased reimbursement. States also must grapple with complying with mandates in the federal Affordable Care Act. The U.S. Supreme Court is expected to rule on the constitutionality of the law sometime in 2012. In the meantime, states must decide how far to go in their own implementation.

Ask state legislators what the top health issues will be in the upcoming 2011 session and the answer is likely to be “Medicaid, Medicaid and Medicaid.” States will struggle to maintain service levels for current enrollees. At the same time, states need to begin planning for the coverage expansions mandated by federal health reform even as many fear the budget math is simply unworkable.